HOW TO TREAT 29 on males) and more recent studies showing females are more at risk. 2
ausdoc. com. au 13 FEBRUARY 2026
HOW TO TREAT 29 on males) and more recent studies showing females are more at risk. 2
As noted earlier, differences in ethnic groups have been observed with a higher prevalence in East and Southeast-Asian ethnicities, with environmental exposures potentially contributing to this difference.
A 2020 study in China demonstrated that children who stay up late are more likely to develop myopia. 13 As with all risk factors for myopia, the mechanisms for this are unclear. Several other factors, including birth order( with first-born children more likely to develop myopia), height, physical activity, intelligence, socioeconomic status, diet and housing, have been investigated for their link to the development of myopia. 2 Further research is needed to verify these links and provide clarity on the aetiology.
Young adults older than 18
As children enter high school and adulthood, the degree of progression of myopia tends to slow, and the myopia eventually stabilises. Despite studies on myopia in older age groups being limited, stabilisation of myopia appears to occur at around the age of 15 in about 50 % of cases, at age 18 in 77 % and in 90 % by 21. 14
Although uncommon, myopia may sometimes first present in adulthood; reports range from 15-81 %. 14 Reports of adult-onset myopia are more frequent in university and academic settings and / or in vocations that require a large degree of near work. The progression of adult-onset myopia is slower than in children. 14
SYMPTOMS
PATIENTS typically report blurriness or difficulty seeing distant objects clearly, for example, seeing the board at school. They may report squinting or eye strain, and poor night vision in particular. Note that the sudden onset of flashes or floaters in a patient with high myopia may indicate retinal detachment and requires urgent referral.
ASSESSMENT
THE activities in box 1 form part of the assessment of myopia.
DIAGNOSIS
EARLY detection is important. Lower hyperopia than expected based on age-norms may be indicative of pre-myopia and should be monitored closely. Age normal cutoffs for refraction appear in table 1. 15
PREVENTION
THE International Myopia Institute brings together leading international experts to reach consensus and provide recommendations based on the latest evidence. They recommend that all children spend at least two hours outside every day to reduce the risk of developing myopia. 16
In Taiwan and Singapore, school-based interventions aimed at increasing outdoor time to prevent myopia have been implemented on a large scale, showing some success. 17 China is now pursuing significant educational reforms to reduce academic pressures,
Figure 3. Retinal tear retinopexy. The arrows indicate retinal scarring postlaser retinopexy of a horseshoe tear.
Anselmuccifederico / CC BY / bit. ly / 3vpXP10
Figure 4. A spontaneous subluxation of the lens in a young woman affected by
Marfan syndrome.
Figure 5. This patient is a four-year-old girl first seen three months earlier with a two-day history of swelling of the upper lid of the left eye and lower lid of the right eye. This was apparently due to a skin eruption. She was thought to have congenital glaucoma and her sclerae were noted to be blue. The corneas protruded anteriorly and keratoconus was suspected. She was-6.00 to-8.00 dioptres myopic. The patient had brachycephaly, there was no nystagmus and her heart was normal. Incidentally, the parents were first cousins. Differential diagnoses included the syndrome of blue sclerotics with a high myopic astigmatism, osteogenesis imperfecta, or Marfan syndrome( she had the typical physique of Marfan syndrome, but her lenses were not dislocated). She was diagnosed with type VI Ehlers-Danlos syndrome on the basis of the blue sclera, high myopia and keratoconus.
US National Eye Institute / bit. ly / 4aUQA1l
Box 1. Assessment of myopia
• History:
— Determine when the symptoms first started and if they are worsening over time; early detection is important for effective management.
— Enquire about family history of myopia or vision problems, as children with parents who have myopia are at greater risk.
— In infants and young adults, enquire about any genetic or systemic conditions that may be a risk factor, for example, a connective tissue disorder.
— Ask about how much time is spent outdoors versus inside, and the time spent on near-related tasks such as reading or using electronic devices.
— Ask about previous ocular and visual assessment in any child with learning difficulties.
• Visual acuity( VA):
— Assess each eye individually using a standard eye chart( typically standardised for six metres).
— By school age( 5-6 or older) VA levels are usually similar to that of an adult, that is, 6 / 6( 20 / 20).
— If VA is reduced, improvement with a pinhole test indicates that a refractive error, rather than ocular pathology, is causing the reduction.
• Refraction:
— This is conducted to determine the level of refractive error.
— Cycloplegic refraction is indicated in young children; it provides more reliable results because of their active accommodation.
— Low levels of hyperopia are to be expected in children younger than nine:
• Absence of this may indicate that they are at risk of developing myopia.
• Ocular health assessment:
— This includes a fundus examination, pupil responses, intraocular pressure assessment and slit lamp examination to rule out associated ocular pathologies. Non-pathological ocular tissue changes may be detected on fundus examination, particularly in cases of high myopia. These changes are most easily observed at the optic nerve head where optic nerve head enlargement, tilting of the optic disc and parapapillary atrophy can be observed( see figures 6,7, 8 and 9).
• Other imaging:
— Ocular coherence tomography and axial length measurement using an ocular biometer are becoming more common and can be helpful for detecting ocular disease and monitoring change over time.